Tourette Syndrome In Children

What is Tourette syndrome in children?

Tourette syndrome is a disorder that causes your child to have tics. A tic is when your child makes sudden, fast movements or sounds that he cannot control. Tourette syndrome is also called Tourette’s disorder or TS. TS is more common in boys and usually begins between the ages of 3 and 8 years. Your child's tics may be mild and get more severe (bad) when he is a teenager. As your child becomes an adult, his tics may go away on their own.

What causes Tourette syndrome in children?

The exact cause of TS is not known. Caregivers believe TS may be caused by the make up of your child's genes. Genes are little pieces of information that tell your child's body what to do or make. TS may occur when your child has problems with the nerve cells in his brain. These nerve cells help control your child's movements, behavior, emotions, and thought processes. Your child's genes may cause the nerve cells to be overactive, leading to TS.

What increases my child's risk of having Tourette syndrome?

Ask your child's caregiver for more information about these and other risk factors for TS:

• Family history: Your child is more likely to have TS if a close family member has TS.
  
  
• Pregnancy problems: Problems that can occur during pregnancy and just before and after birth can increase a child's risk for TS. Vomiting often while pregnant may cause changes in how the unborn child's nerve cells grow. When this occurs, the risk for the child having TS increases.

What kinds of tics will my child with Tourette syndrome have?

Your child may have tics that start and end quickly or tics that start slowly and last longer. Your child may only have a few tics each week or he may have up to 100 tics in one minute. Your child's tics may be worse when he is alone, stressed, tired, excited, or worried. Your child may have warning signs before his tics begin, such as feeling cold, warm, itchy, or tingly. Your child may feel heaviness in his body and feel an urge (need) to have a tic. When the tic occurs, these feelings go away. Your child may have fewer tics when he is concentrating, doing activities, or sleeping. At times, your child may be able to stop a tic from occurring. This may cause discomfort or a build-up of pressure in his body, causing him to have many tics afterwards. When your child has tics, he may have the following:

• Motor tics: Simple motor tics are short, quick, uncontrolled movements of one body area. Complex motor tics occur when your child has many simple motor tics at one time. Your child may also have many different, uncontrolled movements with complex motor tics.
  
  
• Vocal tics: Simple vocal tics are when your child makes uncontrolled noises and sounds. Complex vocal tics are when your child speaks words or phrases without having control over what he is saying. Your child may have motor tics before he starts having vocal tics.

What happens when my child has motor tics?

Your child may do any of the following when he has motor tics:

• Bang his head, punch his face, bite himself, or scratch and poke at his eyes.
  
  
• Blink his eyes, twitch his nose, shake or turn his head, or shrug his shoulders. Your child may also make twisting facial movements.
  
  
• Copy another person's movements or touch other people. Your child may also make inappropriate gestures.
  
  
• Grind his teeth, tense (tighten) his belly, or vomit (throw up).
  
  
• Hit, kick, or throw things. Your child may jump from high places or do exercises for no known reason.
  
  
• Slap his hand, tap his fingers, stamp his feet, or shake his arms or legs.

What happens when my child has vocal tics?

Your child may do any of the following when he has vocal tics:

• Bark, sniff, yelp, squeak, whistle, or make a sucking noise.
  
  
• Clear his throat, cough, make a hiccup noise, or grunt.
  
  
• Copy the sounds or words of another person.
  
  
• Curse, shout, scream, or say inappropriate things.
  
  
• Make the same sound or noise over and over again.
  
  
• Mumble words or sentences.

What conditions are common in children with Tourette syndrome?

Ask your child's caregiver for more information about the following:

• Behavior and mood problems: Children with TS are more likely to also have attention deficit hyperactivity disorder (ADHD) or obsessive compulsive disorder (OCD). ADHD is when your child is overly active or restless and has trouble concentrating or paying attention. OCD is when your child has unwanted thoughts that he cannot stop thinking about. With OCD, your child may also repeat certain movements or actions, such as handwashing.
  
  
• Mood disorders: Children with TS may also have mood disorders. This includes depression (deep sadness) and anxiety (excess worry). Children with TS may also have bipolar disorder, which is both depression and mania. During periods of mania, your child may be very active and easily angered.

What other troubles might my child with Tourette syndrome have?

• Your child may be teased or bullied by other children. He may feel embarrassed about his tics and have low self-esteem (feel bad about himself).
  
  
• Your child may feel pain when he has certain motor tics.
  
  
• Your child may have problems controlling his anger. He may have temper tantrums, bully other children or animals, or harm himself.
  
  
• Your child may have trouble falling or staying asleep. He may also have bad dreams and sleepwalk.
  
  
• Your child may have trouble learning in school.

How is Tourette syndrome in children diagnosed?

Your child's caregiver will ask many questions about your child's tics and health history. Tell your child's caregiver when the tics started and how often your child has tics. Tell the caregiver how often the tics occur, how bad they are, and if they interfere with daily activities. Tell your child's caregiver if a family member has TS or another tic disorder. Your child's caregiver may do testing to check your child's brain function. Your child's caregiver may check your child's eyes, strength, memory, and problem solving ability. Tests may also be needed to check for other conditions, such as ADHD, OCD, and learning problems. Caregivers use a guide to diagnose TS. The following must be true for your child to be diagnosed with Tourette syndrome:

• Your child has had many motor tics and at least one vocal tic since the illness began. The tics may have happened together or separately.
  
  
• Your child's tics started before the age of 18.
  
  
• Your child has many tics in one day, almost every day, or on and off, for at least one year. During this time, your child did not go at least three months with no tics.
  
  
• Your child’s tics are not caused by medicines, drugs, or another medical condition.

What treatments may be needed to help my child with Tourette syndrome?

• Biofeedback training: Biofeedback is a special way for your child to control how his body reacts to stress or pain. Electrodes (wires) are placed on different parts of your child's body, such as his chest. The electrodes are attached to a TV-like screen that shows your child's heartbeat. Caregivers can then teach your child how to control his bodily response when he becomes upset. For example, if his heart rate speeds up, he may learn how to slow it down. This may help your child manage his stress, which can help decrease his tics.
  
  
• Cognitive behavioral therapy: Cognitive behavioral therapy (CBT) helps your child learn to control his behavior, thoughts, and emotions. CBT may help your child better understand TS and help him cope with his symptoms. CBT may also help your child learn ways to improve his self-esteem and how he gets along with others.
  
  
• Habit reversal therapy: During habit reversal therapy (HRT), caregivers help your child learn to manage his tics. Caregivers help your child learn new behaviors to take the place of his tics. These behaviors can help decrease how often your child has tics. Your child may also learn to decrease the strength of his tics.
  
  
• Neuropsychiatric testing: Neuropsychiatric testing is done for children with TS who have trouble learning. The testing can help improve your child's learning and behavior in the classroom. Ask your child's caregiver for more information about neuropsychiatric testing.
  
  
• Parent management training: During parent management training, you will learn ways to help you cope with your child's TS. If your child has behavior problems, you may learn ways to help him improve his behavior. You may learn parenting techniques, such as the use of rewards and discipline for your child's behaviors. You will also learn ways to help promote a positive relationship with your child.
  
  
• Relaxation therapy: Relaxation therapy teaches your child how to calm his body and mind. Your child may be taught to relax his muscles and breathe deeply. The goal is to decrease your child's physical (body) and emotional (mind) stress. Relaxation therapy may help your child learn to control his tics.
  
  
• Social skills training: Social skills training helps your child learn to get along with others, including family and other children his age. Your child's caregiver will teach your child how to behave toward others and talk to others properly. This training may help decrease his feelings of stress and poor self-esteem so he can better cope with his TS.

What medicines may be used to treat my child's Tourette syndrome?

Medicines may be given if your child's tics are painful or his tics cause him harm. Medicines may also be given if your child's tics make it hard for him to do his normal activities. Medicines used to treat your child will depend on if he has TS alone or with other conditions. Ask your child's caregiver for more information about the following medicines:

• Alpha 2 adrenergic agonists: Alpha 2 adrenergic agonists may help decrease your child’s tics. The medicine may help decrease anxiety and trouble sleeping. If your child also has ADHD, these medicines may help decrease his ADHD symptoms.
  
  
• Antidepressants: Certain antidepressant medicine may help decrease your child's tics. The medicines may help decrease aggressive (anger and violence) behavior. If your child also has OCD, antidepressant medicine may also help control his OCD symptoms.
  
  
• Antipsychotics: Antipsychotic medicines help your child's nerve cells work better so that his tics decrease. If your child acts out with aggression, antipsychotics may decrease his aggressive behavior. Antipsychotic medicine may cause problems with how your child’s body moves.
  
  
• Atypical antipsychotics: Atypical antipsychotic medicines are also called second generation antipsychotics. The medicine may help decrease your child’s tics and aggressive behavior. Atypical antipsychotics have a decreased risk of causing movement problems.
  
  
• Botulinum toxin: Your child may be given injections (shots) of botulinum toxin (Botox) to help control his tics. The shot of medicine is given into your child's muscles to help weaken the muscles involved in his tics. The medicine helps decrease how often, and how severe his tics are. Botox injections may also help control vocal tics.
  
  
• Mood stabilizers: Mood stabilizers may help control quick changes in your child's mood that happen for no reason. The medicine may also help decrease the side effects of other medicines, such as movement problems.

What are the risks of Tourette syndrome in children?

• Medicines used to treat TS may cause your child to eat more than usual and gain weight. Medicines may cause your child to have anxiety, trouble sleeping, and trouble with movements, such as walking. Certain medicines may cause your child's head to turn to one side, or his jaw to lock in one place. If your child gets Botox shots, the muscles where the shots are given may feel sore and weak. Some medicines may cause a serious condition called neuroleptic malignant syndrome. This may cause your child to have a high fever, muscle stiffness, and problems thinking clearly. Your child may also have heart, eye, and stomach problems from certain medicines.
  
  
• If your child's TS is left untreated, his tics may get worse. Your child may get injured if his tics become more severe. TS may change the way your child thinks of himself and how your child gets along with others. Your child's condition may make it hard for him to do his normal activities. Your child may have learning problems, making it hard for him to function well in school. He may become depressed and anxious, and have trouble controlling his anger. Your child's risk for abusing alcohol or drugs may increase. Your child may have thoughts of hurting or killing himself or others. Talk with your child's caregiver if you have questions or concerns about your child's condition, treatment, or care.

How can I help my child with Tourette syndrome?

• Help your child manage his stress: Stress may make your child's TS worse. Help your child learn ways to control his stress. Deep breathing, muscle relaxation, meditation, and listening to music may help your child cope with stressful events.
  
  
• Learn and teach others about TS: Learn about TS and teach family, teachers, and classmates. This may help them understand your child's TS and accept and support him. Teaching your child’s classmates about TS may also prevent them from teasing or bullying him.
  
  
• Treat other problems or conditions right away: Watch your child for signs and symptoms of other conditions, such as learning or mood problems. Talk with your child's caregiver if your child is having trouble in school. Tell your child's caregiver if you feel your child is becoming depressed or anxious.

Where can I find support and more information?

TS can be a life-changing condition for your child and your family. It may be hard for you and your child to accept that he has TS. Your child and those close to him may feel angry, sad, or frightened. These feelings are normal. Encourage your child to talk with his caregiver, family, or friends about his feelings. Ask your child's caregiver for information about support groups for you and your child. These are groups of parents and children also coping with TS. You can also contact the following:

• Tourette Syndrome Association
  42-40 Bell Boulevard
  Bayside , NY 11361-2820
  Phone: 1- 718 - 224-2999
  Web Address: http://www.tsa-usa.org
  

• Worldwide Education and Awareness for Movement Disorders
  WEMOVE
  204 West 84th Street
  New York, , NY 10024
  Web Address: www.wemove.org
  

When should I call my child's caregiver?

Call your caregiver if:

• You and your child cannot make it to your child's meeting with his caregiver.
  
  
• Your child is having side effects from his medicine, or his medicine is not helping.
  
  
• Your child is not sleeping well or sleeps more than usual.
  
  
• Your child is having muscle spasms (twitching) or trouble walking.
  
  
• Your child has new tics, or his tics are getting worse or preventing him from doing his normal activities.

When should I seek immediate care?

Seek care immediately or call 911 if:

• Your child seems to be getting very upset, threatens someone, or is violent. This may include talking loudly or shouting, or becoming very demanding (telling others what to do).
  
  
• Your child tells you he feels like hurting himself or others.
  
  
• Your child has hurt himself or someone else.
  
  
• Your child has a high fever, muscle stiffness, and problems thinking.
  
  
• Your child has new changes in his vision.

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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